Provider Demographics
NPI:1578537908
Name:NAGAHORI, LOUISE SETO LEW (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:SETO LEW
Last Name:NAGAHORI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:LOUISE
Other - Middle Name:SETO
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:525 S SHELTON ST UNIT 107
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2829
Mailing Address - Country:US
Mailing Address - Phone:818-429-8885
Mailing Address - Fax:
Practice Address - Street 1:200 E DEL MAR BLVD
Practice Address - Street 2:#302
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2544
Practice Address - Country:US
Practice Address - Phone:626-683-8536
Practice Address - Fax:626-683-8236
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5473225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant